I am a family physician practicing in Toronto, Ontario. I will be implementing an Electronic Medical Record in my practice, starting in March 2006. This blog is a diary of what happened.

Saturday, March 31, 2007

One year into implementation: different levels of EMR adoption

April 3rd will mark a year since EMR start-up. I can no longer even imagine practicing with paper-based records.

My FHN group met last week; we took stock of how we are doing. Two of the nine of us are now using the EMR full-time. Two are not using it at all, and really never started, other than for billing/scheduling. The reasons for that include front staff not agreeing to use EMR; not being able to type; not really being ready to change and so not putting in the needed time and effort. We are not making our colleagues feel guilty about this; they will decide to change (or not) at their own pace.

Eight of the nine of us are now receiving lab reports electronically; one never notified the labs and therefore never started. We are still receiving duplicated paper copies of the labs; this is just shredded at my office, I don't even look at it anymore. We have to notify the labs as a group when we are ready to stop the paper reports, and so it looks like this won't happen for a while.

Of the seven EMR users, all are entering CPPs--most of those are now done. Five of us are documenting at least some encounters in the EMR, and four are prescribing electronically. I am the only one who has scanned and shredded all my paper charts; one of my colleagues is scanning a couple of relevant reports in, and then taking the paper chart off-site.

What we decided at the meeting was to have the two consistent users available as a resource to our five colleagues who are still transitioning. We offered to help either at our offices, or at their office, for individual booster sessions. One of my FHN colleagues already came to my office for a couple of hours. I think this will help, but the offer may not continue to be taken up unless I push for it; we just tend to get too busy with day to day practice.

It is interesting that we are comfortable with different stages and speeds of adoption. This is fairly easy in my group, since we practice in different locations; failure to adopt EMR in one office has a minimal effect on the other offices. Even one complete non-adoption in a two physician office (as with my own practice partner) does not have to stop EMR implementation. This must be different when several physicians practice in a single location; there will be more push to implement, and more peer-to-peer support, so perhaps more successes at a year, but also more problems if some physicians are not ready to implement.

Someone in my group said that EMRs are like onions, they have layers. We need to explore these layers at our own pace, with help for the inevitable tears. We're slowly getting there.